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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/2/17 <br />Gerlach <br />Department IT <br />BPW Date 3/16/17 Phone Extension 6209 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />H Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />M Other: Final cost chanae <br />Company or Vendor Name Hewlett-Packard <br />New Vendor ❑ Yes ® No <br />MBE/1NBE Contractor ❑ MBE ❑ WBE <br />it Yes, Approved by Purchasing <br />MBE/INBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name HP Schedule 13 <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />N/A <br />IT Lease <br />279-0672-415-37-11 /12 <br />$ 1678.70 <br />48 Months <br />Changes in quantity and price <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc <br />Amount of U Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />Sue Gerlach <br />Dispersal After Approval <br />